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PubMed1990

Reinforcement of colon anastomoses with polyglycolic acid mesh: an experimental study.

Polyglycolic acid (PGA) meshes have successfully been used in the treatment of injured parenchymatous organs. In our study we investigated the value of PGA meshes for reinforcement of colon anastomoses in a rat model. In 75 Wistar rats the transverse colon was transected and reanastomosed in a single-layer technique. The anastomoses in half of the animals were performed with 6 stitches. In the other animals the anastomoses were performed with 4 stitches only and were therefore supposed to leak. In half of the animals of each group a PGA mesh was used to cover the anastomoses. Animals of each group were sacrificed after 2, 4, 8, 30 and 60 days. The bursting strength of the anastomoses was determined and the anastomosed region was examined histologically. The results demonstrate that regardless of how the anastomosis was applied motility disorders, delayed healing or leakage followed by peritonitis only occurred in animals in which a PGA mesh was used. The determination of the bursting strength also showed a marked decrease in all rats in which the anastomosis was reinforced with a PGA mesh. We therefore conclude that PGA mesh application in colon anastomoses results in impaired healing, which is probably due to reduced peritoneal or omental contact.

Anastomosis, Surgical↗

PubMed2002

The motor efficacy of the artificial colonic pacemaker in colonic inertia patients.

We have recently demonstrated that the colon possesses at least 4 pacemakers which presumably generate electric waves and that colonic pacing evokes electric activity in colonic inertia. We tested the hypothesis that electric waves produced by artificial colonic pacing in colonic inertia patients may initiate colonic motilitiy and effect evacuation. 17 patients with constipation due to total colonic inertia were divided into 2 groups: 10 (age 45.6 ( 6.3 years, 7 women) in the study group and 7 (age 43.7 ( 5.8 years, 5 women) as controls. 7 healthy volunteers were included in the study. Colonic pacing was tested at 2 sites of pacemakers: mid-transverse colon and colosigmoid junction. A stimulating electrode was hooked to the colonic mucosa at the pacemaker site and 2-3 recording electrodes distally to it. Healthy volunteers showed resting electric waves in the form of pacesetter and action potentials which increased significantly on colonic pacing. Inertia patients exhibited no basal electric activity. Colonic pacing in the study group evoked electric waves and caused expulsion of small volume balloon. Balloon distension at pacemaker site produced mass movement of balloon, while away from pacemaker site step-wise movement. In conclusion, colonic pacing evoked electric waves in colonic inertia patients and effected balloon expulsion. We postulate that the pacemaker generates electric waves which spread along pacemaker branches that are composed of interstitial cells of Cajal and nerve fibers of the enteric nervous plexus and effect colonic mass contraction. Ex-pacemaker stimulation presumably leads to local activation of interstitial cells of Cajal and segmental step-wise contraction.

Action Potentials↗

PubMed1993

[Combined operations with resection of the colon for locally disseminated stomach cancer].

The 20-year experience with performance of combined interventions for locally spread gastric cancer is summarized. Resection of the stomach and colon was performed in 29 patients, gastrectomy with resection of the transverse colon--in 28, gastrectomy with the variants of hemicolectomy--in 5. There were 19 radical operations, and 43 palliative ones. Gross invasion of gastric tumour into the colon was revealed in 36 patients. Of them in 19, it was histologically confirmed. The postoperative complications were noted in 19.3%, the postoperative lethality was 9.7%.

Adenocarcinoma↗

PubMed2002

Clinicopathological trends in colorectal cancer in a tertiary care hospital.

OBJECTIVE: This study aims to retrospectively analyze the pattern of patients with colorectal cancer seen in King Abdul Aziz Hospital and Oncology Center, Jeddah, Kingdom of Saudi Arabia from January 1992 through to December 1997, with a view to determine various epidemiological and clinopathological features of the disease. METHODS: All cases of colorectal cancer presented to King Abdul Aziz Hospital, Jeddah between January 1992 and December 1997 were retrospectively reviewed and the data was analysed to determine age, gender, ethnicity, subsite distribution, clinical presentation, histological type and staging of disease. RESULTS: A total of 160 patients were included in the study, with 78% of them being Saudi Nationals. The male to female ratio was 1:0.8. The mean age was 56.3 + 14.98 years. The peak age of onset was in the 6th and 7th decade. The duration of symptoms varied from one to 24 months with the majority of patients having symptoms for more than 6 months. Sixty-eight point two percent of these patients had primary disease originating from rectum or sigmoid colon, whereas 22.5% of patients had primary disease involving ascending and transverse colon, Anemia was present in 55% of patients. Among the 160 patients, 82.5% of them were histologicaly found to have adenocarcinoma. A total of 38.8% of patients were in stage B and 38.1% of patients were in stage C of Aster-Coller classification. No patients was found to be in stage A. CONCLUSION: In general, we share many epidemiological features of developing countries for colorectal carcinoma. These included left sided subsite distribution and delayed presentation of the disease in an advanced stage. We stress the significance of public health education and a national screening program regarding colorectal cancer to improve the outcome.

Adenocarcinoma↗

PubMed2000

Safety of colonic anastomosis following portal triad occlusion in rats.

Traumatic colon injuries frequently coexist with liver injury. Stopping the bleeding from hepatic pool may require complete portal triad occlusion. The possible effects of portal venous occlusion on healing of colonic anastomosis were examined using a rat model. A colo-colonic anastomosis following resection of a 1 cm segment of the transverse colon was done with just a simple manipulation on the liver and portal triad in the group A. In the group B the portal triad was clamped for 15 minutes. Then, the clamp was released for a thirty minutes reperfusion time. Subsequently, the same technique in the control group for colonic resection and anastomosis was applied. Ischemia/reperfusion resulted in histologically proven alterations in the large bowel in the group B. However, colonic tissue superoxide dismutase values showed no significant differences between the groups. On day 7, no differences were recorded in bursting pressures of the anastomoses and the hydroxyprolene levels of the anastomotic tissues of the two groups. These findings suggest that colonic anastomosis after portal triad occlusion is safe in the absence of peritonitis.

Anastomosis, Surgical↗

PubMedDate not supplied

[Intestinal tuberculosis. The radiologic aspects of a disease not to be overlooked].

Intestinal tuberculosis still exists in the Western world, where it is usually underestimated and often mistaken for Crohn's ileo-colitis or cancer. The authors report the results of 4 cases of intestinal tuberculosis observed between 1983 and 1988. The cases are discussed in the light of the epidemiological data emerging from a review of recent medical literature. The danger is that the disease, which is endemic in Asian and African regions, may spread again in the Western world fostered by intensifying migrations of people and by the spreading of AIDS. According to recent experience, a negative chest film and Mantoux skin-test no longer have a negative predictive value for intestinal tuberculosis. In the radiological differentiation from Crohn's disease it is useful to keep in mind some topographic features of TBC: the systemic non-discontinuous involvement of both sides of ileocecal junctions; the unusual presence of ileal lesions, with no cecal lesions, and localizations below the transverse colon. Useful differential morphological criteria can be: star-like or transverse ring-shaped profile of isolated ulcerations, tubular ileocolic junction with retracted cecum and open valve, and uniformity of lesion in the comprehensive picture of the clinical case.

Crohn Disease↗

PubMed2004

Cancer of the colon and rectum in a Jamaican population: diagnostic implications of the changing frequency and subsite distribution.

The aim of this study was to examine the clinical and pathological characteristics of colorectal cancer in Jamaica, to determine whether there was a change in the anatomic distribution and clinical presentation and to discuss the options for diagnosis and management. A comprehensive retrospective review of patients newly diagnosed with colorectal carcinoma was conducted at The University Hospital of the West Indies by reviewing both patient records and pathological data. These data were compared with previous reports of patients with colorectal cancer seen in Jamaica. One hundred and forty-seven patients were studied There were 85 females and 62 males with a female to male ratio of 1.37:1. The median age was 65.5 years (range 19 to 94 years). The predominant symptoms were abdominal pain in 91 patients, change in bowel habit in 77 patients and rectal bleeding in 74 patients. Sixty patients presented with weight loss and 28 with a rectal mass. The most common tumours were right-sided colonic cancers in 42 patients (28.5%) followed by sigmoid colon in 30 (20.4%) rectum in 34 (23.1%) and left and transverse colon accounting for 16 and 10 cases respectively. Most of the tumours were well or moderately differentiated adenocarcinomas. Only eight patients presented with Dukes' A disease, 50 with Dukes'B, 53 with Dukes'C disease and 34 with advanced disease. The findings showed that sigmoid and rectal tumours accounted for 43.5% of cancers. The colon/rectum ratio in this series was 3.3:1 indicating a significant proximal shift of colorectal cancers in this population in keeping with recent reports. The results of the current study suggest that the sub-site location of colorectal cancers seen is similar to that reported in high incidence countries such as the United States of America and parts of Europe but differs from the African continent which has a high proportion of rectal tumours. This right-sided preponderance also differs from previous studies in Jamaica, which report a higher incidence of rectal lesions The detection of early colorectal carcinoma will require screening at a stage when the disease is asymptomatic in order to improve the chance for cure. The data presented here imply that screening programmes should allow evaluation of the entire colon rather than the distal 25 cm.

Adult↗

PubMed1986

Colonic transit scintigraphy. A physiologic approach to the quantitative measurement of colonic transit in humans.

Colonic transit scintigraphy was developed to quantitatively evaluate colonic transit. Using this technique the progression of a radiolabeled marker from cecal instillation to defecation was studied in 7 normal male volunteers. An 8-ml bolus containing 50 mu Ci of indium 111-diethylene triamine pentaacetic acid was instilled into the cecum via a 2-mm tube, which was passed orally, and serial scintigrams were obtained over 48 h. By 48 h, 70.7% +/- 9.1% (mean +/- SEM) of the instilled activity had been defecated. The cecum and ascending colon emptied rapidly, with a half-emptying time of 87.6 +/- 27.0 min. Geometric center analysis showed an initial logarithmic progression of activity in the proximal colon and a linear progression distally. This study suggests that the transverse colon, not the cecum and ascending colon, may be the primary site for fecal storage. Colonic transit scintigraphy is a safe, physiologic, and quantitative method for evaluating the colonic transit of fecal material and may provide a useful tool for evaluating normal and abnormal large intestinal physiology.

Adult↗

PubMedDate not supplied

[A major visceral anomaly from malrotation of the primitive digestive tube (author's transl)].

Report of a case of major anomaly of the primitive digestive tube. Due to gastric malrotation the stomach was located to the right, behind the right lobe of the liver and the duodenum ran upward and to the left, passing behind the major biliary tract (mirror image of the normal gastroduodenal structure). The small intestine having undergone a normal rotation, the splenic flexure did not exist, while the ileum and colon gave an image of inversed "Mesenterium commune" (absence of the transverse colon, the ascending colon to the right and all the small intestine reassembled to the left). The patient, who presented with a choledocholithiasis underwent an Oddian sphincterotomy in an unusual position.

Barium Sulfate↗

PubMed1984

[2 cases of solitary metastasis to the large intestine from gastric carcinoma].

Localized metastatic foci of the colon from gastric cancer have been reported in only a few cases. Tow cases of gastric cancer were reported. One relapsed in the form of a localized lesion at the sigmoid colon (Case 1) and the other at the rectum and the transverse colon (Case 2) after curative resection of gastric cancer. From the results of clinical examinations obtained from these cases, it may be reasonable to postulate that peritoneal dissemination and/or lymphatic invasion of cancer was the main cause of solitary metastasis to the large intestine.

Adenocarcinoma↗

PubMed2004

[A case of hepatic metastasis from colon cancer successfully treated with 5-FU, levofolinate (l-LV) and low-dose CPT-11].

The patient was a 67-year-old man in whom hepatic metastasis from transverse colon cancer was detected 15 months after transverse colectomy (D2). We treated the patient by systemically administering 2 courses of 5-FU 750 mg/day with l-LV 350 mg/day (once weekly for 6 weeks per course). Assessment of therapeutic effects by CT showed PD in the patient. As a second-line therapy, we treated the patient by systemically administering 3 courses of 5-FU 750 mg/day, l-LV 350 mg/day and CPT-11 40 mg/day x 3 days (once a week for 4 weeks per course). After 3 courses of this chemotherapy, CT examination revealed a reduction in the tumor size of the liver, and CEA levels decreased at the end of this chemotherapy. This chemotherapy also showed no high-grade toxicities. l-LV/5-FU/low-dose CPT-11 seems to be effective for metastatic colon cancer, and safe from the toxicity standpoint.

Adenocarcinoma↗

PubMed1999

Sigmoid volvulus: study from a north Indian hospital.

PURPOSE: The aim of this study was to review our experience with sigmoid volvulus and to compare the various surgical procedures performed for treatment of sigmoid volvulus. METHODS: A retrospective study of 111 patients with sigmoid volvulus treated at University Hospital in northern India during last six years was performed. RESULTS: Mean age for sigmoid volvulus was 51.1 +/- 15.3 years, with a male-to-female ratio of 2.5:1. Duration of symptoms was 4.3 +/- 2.6 days. Plain radiographs of the abdomen suggested the diagnosis in 76 cases (68.47 percent). Resection of the bowel was performed in 40 cases with gangrenous sigmoid colon and 6 cases with viable colon. Nonresectional procedure in the form of colocolopexy (fixation of sigmoid to transverse colon) or extraperitonealization was performed in 13 and 44 cases, respectively. Mortality was 6.3 percent (n = 7). No recurrence was seen after resection and extraperitonealization, whereas 5 of 13 cases (38.5 percent) had recurrence after colocolopexy. CONCLUSION: Resection and extraperitonealization of the sigmoid colon are the suitable alternatives for nongangrenous sigmoid volvulus. Colocolopexy is not indicated, because of the associated high recurrence rate.

Aged↗

PubMed1989

Gastric fistulas in Crohn's disease. Report of cases.

Nine cases of gastric fistula occurring in patients with Crohn's disease were treated at The Mount Sinai Hospital over the past three decades. Six cases were found in a review of 1480 patients with Crohn's disease admitted between 1960 and 1983. Three others seen at this institution outside the time frame of the author's study have also been included. Among six new cases, five with cologastric fistula occurred among 907 patients with Crohn's disease involving the colon (0.6 percent), while only one with ileogastric fistula was encountered among 1211 patients with ileal disease (0.08 percent). Fistulas between the stomach and colon always originated in an area of colitis, usually passing from distal transverse colon to greater curvature, but occasionally from midtransverse colon to antrum. The only pathognomonic clinical features were feculent vomiting, eructations, or odor. Diagnosis usually was made by barium enema or, less frequently, by upper gastrointestinal series; rarely, the gastric fistula was found unexpectedly at surgery. The conventional and recommended therapy is colectomy with wedge excision of the stomach. Medical treatment with 6-mercaptopurine has been completely successful in one patient and intermittently successful in a second patient.

Adult↗

PubMedDate not supplied

Entrapment of the colon following diaphragmatic injuries: report of eight cases.

With a rise in the incidence of severe injuries, we are seeing increasing numbers of patients with colonic entrapment occurring at the sites of diaphragmatic injuries. The initial injury might have occurred recently or it might have occurred as long as 25 years before. Blunt trauma, stabbings, and infection accounted for the initial trauma in our patients. Acute symptoms implicate the cardiorespiratory system as a result of interference with respiration and the filling and function of the heart. Acute or chronic gastrointestinal symptoms may suggest intestinal obstruction or functional bowel disorders. The proper diagnosis of colonic entrapment depends upon a high index of suspicion and proper studies. Chest x-rays, fluoroscopy, barium-enema examinations and contrast studies of the upper gastrointestinal tract are essential. Acute cardiorespiratory enbarrassment necessitates prompt surgical intervention. When subdiaphragmatic injuries are suspected, an abdominal incision is necessary. In long-standing cases where the abdominal viscera are intact, the thoracic approach is preferable. At times, the combined thoraco-abdominal incision may be preferable. Diaphragmatic injuries resulting in colonic entrapment occurred most often in the left hemidiaphragm, which is relatively unprotected. In seven of our eight patients, the left diaphragm was the site of herniation. The liver on the right side serves to protect this area from herniation. Only the largest defects permit displacement of the liver into the right chest. Only one of our patients had such a defect. Patients with long-standing cardiac or gastrointestinal symptoms suggestive of colonic entrapment should have a THOROUGH MEDICAL evaluation before any operative treatment is advised. We have reviewed the cases of eight patients in whom infection, stabbings and blunt trauma resulted in diaphragmatic herniations with subsequent colonic entrapment. The splenic flexure of the colon protruded through the defect in three of our eight patients. The transverse colon was located above the diaphragm in five.

Adult↗

PubMed1997

Role of tachykinins in castor oil diarrhoea in rats.

1. We set out to ascertain the role of tachykinins, neurokinin A and substance P, in castor oil-induced diarrhoea in rats as disclosed by the inhibitory effect of the non-peptide NK1- and NK2-receptor antagonists. SR 140333 and SR 48968, respectively. 2. SR 48968 (0.02 to 20 micrograms kg-1, s.c. or p.o.), and the opioid receptor agonist loperamide (1-10 mg kg-1, p.o.), dose-dependently prevented castor oil effects: % inhibition vs castor oil, diarrhoea 0 to 100, increase in faecal mass 7 to 90 and water content 16 to 90. SR 140333 (0.02 to 20 micrograms kg-1, s.c.) and the platelet activating factor antagonist SR 27417 (5 to 500 micrograms kg-1, p.o.) did not prevent the increase in faecal water content, but reduced faecal mass (35 to 66%) and diarrhoea (0 to 57%). 3. The R-enantiomers of tachykinin NK1 and NK2 receptor antagonists, SR 140603 and SR 48605 (both at 2 or 20 micrograms kg-1, s.c.) had no effect other than reducing faecal mass at the highest dose tested. 4. SR 48968 (20 micrograms kg-1, p.o.) but not loperamide (10 mg kg-1, p.o.) given 24 h before castor oil, still slightly but significantly reduced by 30% the increase of faecal mass output; both treatments significantly reduced (30 to 70%) the effect of castor oil on faecal water content, although the incidence of diarrhoea was only slightly less than in controls. 5. In castor oil-treated rats, naloxone (2 mg kg-1, s.c.) completely blocked the antidiarrhoeal action of loperamide (10 mg kg-1, p.o.) but not of SR 48968 (20 micrograms kg-1, p.o.): a similar result was obtained on faecal mass and water content. 6. Castor oil strongly increased the occurrence of manometrically recorded propulsive giant contractions (500 to 1000% over control values) of transverse and distal colon, this effect being significantly prevented (80 to 100%) by SR 48968 and loperamide and partially by SR 140333 (35% distal colon, 70% transverse colon). 7. In castor oil free rats, loperamide but not SR 48968 or SR 140333 significantly reduced by 50% the gastrointestinal transit of a charcoal test meal, as well as 24 h faecal mass output. Consistently, loperamide, unlike the tachykinin receptor antagonists, had a dramatic effect on manometric recordings of intestinal motility, reducing all kinds of colonic contractions. 8. Our findings suggest that castor oil diarrhoea in rats entails activation of NK1 and NK2 receptors by endogenous tachykinins, whose antagonists may have a potential as antidiarrhoeal agents free from the constipating action of opioids.

Animals↗

PubMed1995

Free colon transfer for resurfacing large oral cavity defects.

Ideal reconstruction of the oral cavity includes a durable lining that is thin, supple, and innervated, and that provides a lubricated surface that facilitates deglutition and speech. This paper describes the use of free colon transfer for relining the oral cavity. In three patients, segments of transverse colon, split along the antimesenteric border, were transferred as free flaps on the middle colic vessels for large defects involving the alveolar ridge, buccal mucosa, floor of the mouth, tongue, and pharyngeal walls. All flaps were transferred successfully without adverse vascular events, abdominal complications, or oro-cutaneous fistulas. One flap was re-elevated 2 weeks postoperatively for additional mandibulectomy. Two patients received postoperative radiation therapy and another patient received planned preoperative radiotherapy. The mucosal surface of the colon flattens to provide a thin, smooth, supple oral lining that produces moderate mucus, coapts well to the convoluted surfaces of the defects, and is durable to mastication and denture wear. Mucosal biopsy 2 years postoperatively in the nonradiated flap reveals normal colon mucosa with abundant mucin-producing cells. Free colon transfer is a "functional" reconstruction of the oral lining. The donor tissue is abundant and capable of resurfacing large, convoluted oral cavity surfaces with a thin, supple, mucus-secreting tissue that allows unimpaired tongue mobility, swallowing, speech, and denture wear. Furthermore, the presence of nonirradiated, mucus-secreting cells provides an avenue to further augment mucin production by topical and systemic agents.

Alveoloplasty↗

PubMed1996

Gastrointestinal hormone mRNA expression in human colonic adenocarcinomas, hepatic metastases and cell lines.

Aims-(1) To investigate the expression of the four main hormones of the digestive tract by performing reverse transcription polymerase chain reaction (RT-PCR) on a series of samples, comprising tumoral and healthy colonic tissues, hepatic metastases and colonic cell line samples; and (2) to study the patterns of labelling obtained with serological and morphological markers.Methods-After extraction and reverse transcription, gastrin, somatostatin, cholecystokinin (CCK) and transforming growth factor alpha (TGFalpha) mRNAs were detected by PCR and nested PCR using specific primers. The corresponding proteins were detected by immunohistochemistry.Results-The cell lines expressed all four mRNAs. Gastrin mRNA was present in most tumoral and metastatic samples, while the somatostatin transcript was detected in all samples and was frequently overexpressed in the normal colon. TGFalpha mRNA was expressed systematically in tumours of the right and transverse colon, but not in those located in the left colon; the expression of CCK mRNA was systematically absent in the left colon.Conclusions-The data presented here shed some light on the transcriptional events involved in the production of the various hormones present in the gastrointestinal tract, in both healthy and tumoral tissues. The various mRNAs expressed in cell lines are therefore not systematically expressed in the human pathology.

Journal Article↗

PubMed1992

Volvulus of the cecum and large colon caused by multiple mesenteric defects in a horse.

A 2-year-old Standardbred colt was examined because of signs of abdominal pain of 12 hours' duration. Clinical signs of disease, including tachycardia and abdominal distention, and rectal palpation findings of distention and thickening of the ventral colon, were consistent with displacement or early strangulation obstruction of the large colon. Surgical exploration revealed volvulus of the large colon around an axis formed by the dorsal mesenteric attachment of the transverse colon. The cecum could be completely exteriorized and lacked the cecocolic ligament and dorsal mesenteric attachments. The dorsal mesenteric attachments of the right ventral and dorsal colons were also lacking. The viscera were repositioned, and the horse was discharged 13 days after surgery. The horse developed severe colic 6 months later and was euthanatized. Mesenteric volvulus and omental adhesions were found at necropsy.

Animals↗